prove that the atheromatous condition brought about after using certain
drugs, such as alcohol and tobacco, can be ascribed to the adrenals.
Josué, in 1893,[199] showed that by injecting adrenal extracts (solution
1:1000) into the veins of a rabbit, atheromatous patches of the aorta
will appear after five or six weeks. The changes described by Adler and
Hensel from the effects of nicotine confirm the probability that tobacco
acts on the adrenals first, then, by their medium, on the blood-vessels
(see, also, Chapter XLIII).
Footnote 199:
C. R. Soc. biologie, Nov. 14, 1893.
The above observations show that the same is also probable in the case
of alcohol, to which we may add a case of Widal and Boivin, who found in
a young woman dipsomaniac a hyperplasia of the adrenals and atheroma of
the aorta; and to complete the value of these observations we subjoin
those of a series of cases of atheroma by Joshua, in three of which a
hyperplastic condition of the adrenals was found.
It follows logically from the foregoing effects of alcohol and tobacco,
that we must avoid large quantities of these substances if we desire to
keep in a normal condition the heart and blood-vessels, upon the perfect
state of which depends, in a great degree, our chances of a long life
and extended youthfulness.
We will deal further with the latter points in the following chapter.
------------------------------------------------------------------------
CHAPTER XVI.
HYGIENE OF THE ADRENALS AND OF THE CIRCULATORY SYSTEM—A FEW REMARKS ON
THE CAUSE, PREVENTION, AND TREATMENT OF ARTERIOSCLEROSIS.
IN order to obtain the best hygienic condition of the circulatory
system, it is indispensable to avoid all that are harmful to the
adrenals. There can no longer be any doubt that these glands exercise a
controlling influence on the heart and the whole circulatory system.
They are in intimate relation with the principal nerves that regulate
the heart: the sympathetic and the vagus. Thus, for instance, emotions
that act on these nerves excite through them a hypersecretion of the
adrenals and a contraction of the small blood-vessels, with a rise in
the blood-pressure. By the hyperactivity of these glands their
secretion, in larger quantity than usual, is thrown out into the system,
producing toxic effects which result in an atheromatous condition of the
arteries. According to our present knowledge, we imagine this
atheromatosis to be due to the toxic effect of the adrenals quite
independently of the increase in the blood-pressure, for it has been
distinctly shown that even substances which diminish blood-pressure,
such as amyl nitrite, for example, are also capable of producing
atheroma. The toxic effects of adrenalin are proved by the experiments
of Amberg[200] in the laboratories of the Johns Hopkins University.
Footnote 200:
Amberg: Archives Internationales de Pharmakodynamie et Therapie, 1905.
We must especially insist on the fact that high blood-pressure is not a
condition essential to arteriosclerosis. It has been shown by
Sawada,[201] Groedel,[202] and Ferranini,[203] through measuring the
blood-pressure by Riva-Rocci’s instrument, that numerous cases of
arteriosclerosis can arise without any increase at all in the
blood-pressure. According to Professor Romberg,[204] there is only high
blood-pressure in such cases of arteriosclerosis where there is a
diseased condition of the kidneys. According to this leading authority
on heart diseases, high blood-pressure is one of the earliest symptoms
of kidney complication in arteriosclerotic persons. We believe that the
high blood-pressure found in kidney diseases may be brought into
correlation with the previous statement, by the fact that in such
conditions, and especially in sclerosis of the kidneys, the adrenals, if
examined, are frequently found to be hypertrophied, as was noted by
Parkes Weber,[205] Lemaire, and in four cases of Troin and Rivet.[206]
At the last Congress of German Physicians and Naturalists in Dresden,
1907, it was proved by Schur and Wiesel, as also in their previous
communications, that the blood of patients affected with kidney diseases
contained the characteristic substance that gives the adrenalin reaction
with perchloride of iron, and produced mydriasis if dropped into a
frog’s eyes.
Footnote 201:
Deutsche Med. Wochenschrift, No. 12, 1907.
Footnote 202:
Congress für Innere Medicin, 1907.
Footnote 203:
Grom. Int. della Soc. Med., xxvi.
Footnote 204:
Lehrbuch der Krankheiten destergens und der oxlutgefüre. Stuttgart,
1906.
Footnote 205:
Parkes Weber: Transact. Path. Society, London, lviii, 3.
Footnote 206:
Gazette des hôpitaux, Juin 14, 1906.
It is of singular interest that all those agencies that produce a
hypersecretion of the adrenals are the same which are known to be
harmful in causing arteriosclerosis. In the front rank of such are
tobacco, alcohol, and different kinds of poison, such as lead, mercury,
etc.; also infectious diseases, especially syphilis, the important rôle
performed by which, in the production of arteriosclerosis, has been
treated of very competently by Professor Edgreen,[207] of Stockholm, and
Darier, of Paris. Arteriosclerosis can also be produced very frequently
by abundant meat food and by strong tea or coffee. There is as yet no
scientific proof to show that abundant meat food has the same
deleterious action on the adrenals as upon the thyroid, ovaries,
pituitary body, pancreas, liver, kidneys, etc., upon which we have
enlarged in previous chapters of this book; and, moreover, we have no
knowledge of any work written on this subject; but as such a diet is
very efficacious in producing a sclerotic condition of the kidneys, it
may, for these reasons alone, tend to further the development of
arteriosclerosis, considering that so often in such conditions both
kidneys and adrenals are found in a hypertrophic condition. This disease
may be produced by alcohol, tea, and coffee, by causing a great
variation in the tone of the capillaries. According to Professor Romberg
and others, it remains to be proved whether they affect the adrenals at
all; but we have already shown what their action is on the kidneys.
Footnote 207:
“Die Arteriosclerose,” Leipzig, 1898.
To keep the adrenals in good condition and thus prevent
arteriosclerosis, it is necessary to avoid all the above harmful
agencies. It is true that there are some people who can enjoy these
things in large quantities with impunity and without injurious effects
until they reach a considerable age; but it is different when they all
act together. Especially deleterious are mental emotions, grief, and
sorrow, on which we have dwelt in the introduction to this chapter, and
on the effects of which we have previously remarked; they produce a
great variation in the tone and calibre of the blood-vessels. We will
therefore endeavor to treat of the prevention of a prolonged continuance
of this most disastrous agency in our chapters on the hygiene of the
mind. Emotions of a sexual character are, perhaps, more than emotions
from other sources, disastrous to the heart and blood-vessels, as shown
by the fact, which may often be observed, that persons addicted to
sexual excitations frequently die from sclerosis of the coronary
arteries. That the sexual glands are in intimate relations with the
heart, which can often be irritated in consequence of changes in these
glands, especially in women, has been already mentioned.
We should like to add that, as the above agencies are also harmful to
the thyroid gland, the antagonist of the adrenals, its degeneration can
further the development of arteriosclerosis in the same way that
Eiselsberg produced an atheromatosis of the aorta in dogs after
extirpating the thyroid gland. According to Minnich, arteriosclerosis is
very common in people with goiter, appearing in them at a very early
age. Fries and Pineles found that alterations of the blood-vessels
occurred in goats after extirpation of their thyroid gland.
Since arteriosclerosis is so frequent in old age it must be due to the
degeneration of the thyroid and also to the aggregation of all the
above-named harmful agencies during a prolonged period. To avoid it, and
also premature old age, it is, therefore, most essential to guard
against all agencies harmful to the thyroid and adrenals, to which we
have referred above; and this is the best basis for the rational
treatment of arteriosclerosis. It is most fortunate that Dellamare
discovered in old age a hypertrophy of the adrenals.[208]
Footnote 208:
“Recherches sur la senescence des glandes surrénales,” Soc. biologie,
17 Oct., 1903.
All this is greatly strengthened by the recent investigations of Sajous,
which show that besides its action on the blood-pressure and the heart,
the adrenal secretion actually supplies the substance which in the
lungs, takes up the oxygen from the air to sustain life in all our
tissues. It thus becomes evident that harm to our adrenals is bound to
shorten life.
To recapitulate: There exist two chief agencies for the production of
arteriosclerosis: 1. A hyperactivity of the adrenals, causing a rise in
blood-pressure. 2. A degeneration of the thyroid gland, which, when
normal, antagonizes the first by lowering the blood-pressure. Although
from the above-mentioned facts high blood-pressure cannot be considered
as the chief cause of arteriosclerosis, still no doubt it certainly
contributes to it; for each time that there is a rise in the
blood-pressure more blood is forced through the arteries, thereby
causing them to dilate; and after a repeated number of such dilatations
the elasticity of the vessels will eventually be impaired, especially so
in the aged, where one part of the elastic fibers is already replaced by
connective tissue. As a result of the arteriosclerosis the passage of
blood through the capillaries will be impeded, and in consequence the
work of the heart will be increased; likewise the nutrition of the walls
of the vessels will be diminished. The best preventatives of
arteriosclerosis will therefore be: 1. To avoid all agencies which may
tend to cause excessive activity of the adrenals; and 2. To increase the
activity of the thyroid.
Moderation in food is necessary above all things, for much food causes
an increase in the abdominal circulation and a larger amount of blood to
be carried through the vessels; if the food consists of much meat, then
its viscosity is augmented, as previously stated, which indicates that a
vegetable diet, with milk, and little or no meat, is the best; but too
large quantities of milk should not be taken at one time.
Much bodily and other exercises, in excess, such as too much climbing,
should be avoided, as they promote arteriosclerosis by frequent
excitation of the splanchnics and adrenals. As Romberg observed, there
is sclerosis of the arteries in the extremities of persons who do much
physical labor, and Remlinger[209] found the same in the lower
extremities of peasant women who walked a great deal.
Footnote 209:
Remlinger: “Dissertation on Arteriosclérose,” Marburg, 1905.
Not only by a diet, chiefly vegetarian, is the viscosity of the blood
diminished and the circulation facilitated as found by Determann, but
also by means of iodine administered in the shape of iodide of potassium
or iodide of sodium. This has been proved by the experiments of
Ottfried, Müller, and Inada.[210] For many years it has been well known
that iodine can greatly benefit the condition of arteriosclerotic
persons. In combination with a preparation of iodine, Professor
Senator[211] favors the use of nitrites, and Professor Huchard also
recommends nitroglycerine in the intervals between the iodide treatment.
Besides inorganic iodine, it would appear to us logical to try organic
iodine preparations, such as thyroid extracts, the principal element of
which is iodine. For the above reasons it is also necessary to take
special care of the condition of the kidneys, which can be done, as we
have shown, by hygienic and dietetic measures, already described in the
special chapters of this work. An improvement in the condition of the
kidneys, and probably also in the arteriosclerosis, may, in our
judgment, be obtained by the administration of kidney extracts, with
which we will deal more fully in the chapter on the treatment of old age
by organic extracts.
Footnote 210:
Preface of Romberg: Deutsche Med. Wochenschrift, No. 78, 1904.
Footnote 211:
“Therapie der Gegenwart,” March, 1907.
According to Edgreen, about 25 per cent. of the cases of
arteriosclerosis is caused by alcohol. It acts by causing a constriction
of the small vessels (Traube), just as does adrenalin.
But much more harmful in the production of arteriosclerosis is tobacco.
According to Claude Bernard, Huchard, Basch, Oser, Isaac Adler, and
Hensel, tobacco produces a constriction of the small blood-vessels. Thus
nicotin, adrenalin and alcohol have similar actions, which also
corresponds to the observations of Sir Lauder Brunton. We have had a
great many smokers among our arteriosclerotic patients; but, on the
other hand, we quote further on the cases of some great smokers who
lived to a very old age as we have seen. But this latter class is not
numerous.
Similarly, the hygiene of the intestines is of the utmost importance,
especially as poisons generated in the intestines play a leading part in
causing arteriosclerosis, according to Huchard, Senator, and others. We
must take great care to have a daily evacuation of the bowels, and
especially to prevent flatulence, for this distention of the colon or
the stomach, by carrying the diaphragm upward, may interfere with the
expansion of the lungs and thus produce a mechanical hindrance to the
movements of the heart and a free circulation of the blood. Those with a
tendency to angina pectoris must specially avoid such dangerous courses.
Hill climbing, during which not infrequently such people suffer sudden
death, should also be avoided. More than from 1 to 1½ liters of liquids
per day should not be allowed.
------------------------------------------------------------------------
CHAPTER XVII.
THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE INTESTINES AND THE
IMPROVEMENT OF THIS FUNCTION.
THE intestines contain billions and billions of microbes, their number
increasing downward throughout the length of the intestine. The duodenum
contains the least, and in some parts of it there are none at all.
The presence of these bacteria is a great necessity to us, as without
their assistance we could not exist, for they take an active part in
intestinal digestion and help to form the intermediate substances,
especially from albuminous food and fat, for our nutrition. They also
assist fermentation and thus induce a better peristalsis of the
intestines, by which the contents are expressed.
That animals cannot exist without cultures of bacteria in the intestines
is shown by the experiment of Schottelius, who demonstrated that young
chickens could not thrive on a sterilized nutrition, and Nuttall and
Thierfelder had great trouble in keeping their guinea-pigs alive when
feeding them for a time on sterilized milk.
All those bacteria which are found in the intestines are, we may say,
innocuous; they assist digestion and do no harm. But among such are
often virulent bacilli against which, under normal circumstances, we are
well guarded, as the epithelium of the intestines is so wonderfully
arranged that so long as it is in a healthy condition it does not admit
the passage of these microbes; but in the aged, or in those exhausted by
debauchery or previous disease, or when there is an inflamed condition
of the intestines, stagnation of hard masses of fæces for a very long
time cause mechanical lesions of the epithelium when, conditions now
having changed, nothing will prevent these microbes from entering the
walls of the intestines and either cause disease, like typhoid or
tuberculosis, or from passing through and entering into the blood.
Besides these dangerous bacteria many other harmful substances pass from
the stomach down into the intestines, whence they are taken up by the
portal vein and brought to the liver. When the latter is in good
condition so much the better for us, but when they arrive in too large
quantities, or when the liver is more or less degenerated, as in old
people, drunkards, gourmands, etc., then trouble arises.
When the number of bacteria in the intestines is much greater than
usual, certain dangers arise from such a condition, as thereby the
immigration of bacilli into the bile-duct is facilitated causing
inflammation of the gall-ducts and gall-bladder, and subsequently
gall-stone disease. Further consequences of such a condition may be the
closure of the bile-duct, and then no bile can reach the intestines. The
presence of bile, however, is very important, for, according to current
opinion, this exerts an influence on the checking of putrefaction in the
intestines. Bile is a natural antiseptic of great efficacy, and has also
a stimulating effect on the nerves of the intestines, promoting their
peristaltic movements.
It would, therefore, greatly interfere with the useful work of those
organisms normally present if we permitted the formation of enormous
quantities of bacteria, especially of such as are harmful to us; so we
must endeavor to eliminate them and not give them the opportunity to
turn against us, and we must do all in our power to keep the peristalsis
of the bowels in good working order so as to prevent any stagnation of
their contents, as such a stagnation, in addition to favoring the growth
of bacteria, also facilitates the development of auto-intoxication. Even
if it is true that most of the end-products of proteid food in our
intestines, like indol and skatol, are not able to produce severe
poisoning if injected into other animals; still there is no doubt that
in medical practice not infrequently cases are observed where the
retention of all these products together results in very grave
conditions. Thus Ewald[212] has published the case of a woman who, for
about a month, retained the contents of the bowels and in consequence
presented a serious condition of intoxication; after eliminating a large
quantity of fæces—pitch dark—she recovered and the symptoms of
intoxication disappeared. Senator also published a very interesting case
of auto-intoxication with hydrothionuria.
Footnote 212:
Ewald: “Die auto-intoxication,” Berl. klin. Wochenschr., No. 7-8,
1900.
We often have occasion to note cases of persons having no bowel action
for two to three days, who then complain of headache, loss of appetite,
and various nervous symptoms, neurasthenia, etc., all of which may,
perhaps, be regarded as of reflex origin; but when we see in such people
a yellow or yellowish-gray complexion which, after a good purge, resumes
its clear condition, clinically, we regard it as auto-intoxication.
Even if, as already mentioned, most of the elements of albuminous
catabolism are not toxic if injected into animals, still, occasionally,
toxic products can be formed, such as cholin and neurin, which come from
the former. These elements arise from decomposition of the lecithin,
which, of our various foodstuffs, is contained in the greatest quantity
in eggs; and these substances can provoke serious nervous symptoms. In
such cases there is, of course, a stagnation of long duration of the
bowels, but such a condition as the latter can arise without a stricture
or obstruction, although these are the most frequent causes. Another
toxic product is the pepto-toxin of Brieger.
Stagnation takes place in sluggish bowels. As a general rule, fæcal
movement is caused by peristalsis of the intestines, which consists of
circular contractions of the bowel by which the contents are propelled
toward the end of the same; besides these movements there are also
pendular or vermicular contractions of certain parts of the intestines;
all these movements also assist the admixture of the chyme with the
juices of the intestines. All these contractions are caused by impulses
from the nerves which lie in the walls of the intestines, the plexus
myentericus; they can also be provoked by impulses coming from the
central nervous system.
The nerve ganglia that lie in the walls of the intestines can be
influenced mechanically by the contents of the intestines, when such are
bulky, and also when they are fermenting; therefore, the bacteria, by
promoting fermentation, also aid in peristalsis. The bulky condition of
the bowel contents can be best induced by food of the vegetable kingdom
through its cellulose contents, of which tissue the cells of plants or
fruits are largely formed. When these irritating agents act on the nerve
filaments in the intestines, the bowel will contract and expel its
contents.
But when food contains no irritating substances and is easily
assimilated without forming _residues_, or when the innervation by the
vagus is sluggish and the peristaltic movements are slow, the contents
of the intestines can remain longer, especially in the haustra of the
intestines. It may be that the bowels move every day, but that does not
prove that everything in the intestines has been expelled therefrom, for
some amount of fæces can yet remain in the haustra of the intestine even
for many days; so that in such cases there is still a constipation of
one part of the bowels. We have observed, personally, and on patients,
that, after a good opening of the bowels, when a purge is given—for
instance, directly after a meal—a short time afterward there has been
another copious discharge that had evidently remained behind. Thus, no
doubt a retention of fæces, and sometimes a condition analogous to
auto-intoxication, can be caused in people who have the bowels opened
every day, although not to the extent of those having obstruction or
habitual constipation.
To avoid such a condition a good purge should be taken at regular
intervals, say once a week, even by persons who have a movement daily,
in order to eliminate matter which may have remained. It will not be
necessary, naturally, to use a too powerful purgative, but one adapted
to the necessity of the case; taking, as a rule, such a purge as will
act a little better than the ordinary bowel movement, and graduated
according to the strength of the person so using it.
Before closing this chapter we must also briefly insist upon the
importance of the fact, that the secretions of the intestine and of its
glandular annexes have also an anti-bacterial and antitoxic action. Very
important is the rôle of the bile for the disinfection of the intestine,
as it contains two acids, the glycocholic and taurocholic, which possess
highly anti-fermentative properties. As already mentioned, the bile also
assists in the assimilation of fat, and also exercises a stimulating
action on the peristalsis of the intestines.
------------------------------------------------------------------------
CHAPTER XVIII.
ON THE PREVENTION AND TREATMENT OF HABITUAL CONSTIPATION.
WE all know from physiology that the expulsion of fœcal matter from the
intestines takes place in such a manner that the contents therein act as
a kind of _extraneous_ body with stimulating action upon the walls of
the intestines and the plexus myentericus contained in the same.
Consequently there follows a contraction of the walls of the intestines,
and their contents are expelled. All nerves, the plexus myentericus
included, are under the control of the central nervous system, which
creates motor impulses through the medium of the pneumogastric (vagus),
or may cause a check to the peristaltic movements through the
intervention of the splanchnic nerves.
Thus, as we see, different agencies influencing the central nervous
system, like strong emotions, shock, etc., may cause an irritation of
the pneumogastric, the motor nerve of the intestines, and thus occasion
a movement of the bowels. Different toxic products may act also upon the
pneumogastric; strong motor action of the intestine with diarrhœa may
also be caused by the abundant secretion of the thyroid gland, as in
Graves’s disease, where an excess of toxic matters of the thyroid gland
are secreted.
In the same way we can also produce diarrhœa if we give thyroid extracts
in too abundant quantity; but giving the same in more moderate doses
will effect an improvement in the peristaltic movements.
That the thyroid gland has a controlling influence on the innervation of
the intestine is evident from the fact that, when the thyroid is
degenerated, the bowels are very sluggish. Under such conditions we
often find very stubborn constipation; but when we administer to such
persons thyroid extracts for a given time, we note a considerable
improvement of the bowels, which can even go to the extent, if too
excessive doses be given, of causing diarrhœa as already mentioned.
In addition to the thyroid gland, there are other ductless glands which
seem to influence the peristaltic movements by acting on the splanchnic
nerves, and these are the sexual glands. In women they are frequently
altered. Dysmenorrhœa, amenorrhœa, and other troubles are frequent, and
constipation is a typical symptom of such conditions. This may also
serve to explain why women are more often constipated than men.
But the alteration of the sexual glands can also cause constipation in
men, if we may draw the inference from the great frequency of
constipation in diseases of the prostate gland, which to some extent may
be in relation with the subject with which we are now dealing.
In order to avoid constipation we must therefore observe a careful
hygiene of the thyroid, and also of the sexual glands, following the
advice we offer in special Chapters XVIII and XLVIII.
Besides constipation, as above, from the central nervous system, the
same may be caused through the lack of a stimulation which may come from
the intestinal contents. As we have already seen, the peristaltic
movements of the intestine and the expulsion of fæcal matter take place
through the stimulation of the nerves in the intestinal walls by the
intestinal contents, which act either mechanically or by the irritation
which their fermentation causes.
To prevent constipation we must take such nourishment as will act in a
stimulating way, either mechanically, owing to its bulk, or by the
fermentation it causes. In order to have good bowel movements we must
create them, and this is best done, not by a diet of meat and finely
ground cereals, which are absorbed with scarcely any residue to effect
the purpose, but by one of vegetables and fruit, which contain cellulose
in the largest quantity, this substance forming the framework of the
structure in which the cells are imbedded; it constitutes the wall of
the cells. This cellulose provides us with the best residue from food,
which, if present in large quantities, will exercise a mechanically
stimulating action on the intestinal walls.
Vegetables are thus a valuable aid in the prevention of constipation,
and of these the following are the best: spinach, carrots, green beans,
and boiled lettuce, taking into consideration their action as laxative
food. Cabbage also acts well as a bulky food.
Graham bread and brown bread in general, and in particular a special
kind, called “cellulose” bread, are also very good agents with which to
prevent and to treat habitual constipation. Some breads, as various
kinds made from bran, are so coarse that, to a certain extent, they may
be considered as setting up a kind of internal massage of the
intestines.
Not only vegetables, but fruits, by reason of the fruit sugar and acids
they contain, may also prove laxative if taken in given quantities.
Fruits may be taken stewed, as a compote, or baked, as for instance,
apples; they may also be taken _au naturel_ if the condition of the
stomach permits. Of compotes the most laxative are plums, prunelles
(sour figs), and apples; also pineapples, cherries, and various berries,
all of which may also be partaken of in the form of a mush or purée, to
great advantage; also fruit juices and fruit wines, if free from
alcohol.
Of fresh fruits, grapes and, according to our observation, pineapples
also undoubtedly have the best laxative quality, as also have green
figs, which can be taken regularly as a preventive against constipation.
Figs when dried, especially the so-called Olympia figs from Smyrna, or
the California variety, are also most beneficial, their laxative
properties to a certain extent being probably due to the seeds which
they contain, which serve as a means for intestinal massage.
Orange and grape-fruit, taken on an empty stomach in the morning, may
also have a laxative effect, due probably to the quantity of fruit acids
they contain.
We sometimes hear patients complain of constipation after partaking of
milk. According to our experience, this is more often the case when
boiled milk, heated above 60° C., is taken. On the other hand, we
believe that when uncooked milk is taken it may act as a laxative in
many persons, due to the action of milk-sugar and acid. Acidulated milk
may have this property in a greater degree, as also may buttermilk, and
especially whey; all of these are, on the whole, good laxatives.
The diet of those suffering from habitual constipation should be as
follows: In the morning, on rising, take a glass of cold water and an
orange. For breakfast, one or two oranges or several slices of fresh
pineapple, or, in countries where one is so fortunate as to obtain such
delicious and wholesome fruit, a grape-fruit; after that one or two soft
boiled eggs, cereals, Graham or brown bread, or one of the kinds of
coarse breads rich in cellulose, and fresh butter thickly spread on the
bread (if the stomach is good). Then follow with orange marmalade or
purée of prunes, ending with some grapes. Honey (another excellent
laxative) may also be added. Two glasses of milk or more, for those who
can stand it; in fact, as much as they desire. For dinner, the following
is recommended: Roast or boiled meat, two sorts of green vegetables (by
preference spinach), French beans, carrots, boiled lettuce, one course
of stewed compote of fruit, and finish with dessert of grapes, figs
(dried or green), or preserved plums (California or Bordeaux). For
drink, mineral waters, such as the various light American kind, either
mixed with wine or alone. Alkaline waters, such as Biliner, Vichy, etc.,
if taken very cold, may also contribute to the laxative action. For
supper, something akin to breakfast. As we shall point out in the
chapter on the hygiene of food, we recommend meat only once a day.
We are confident, from experience gained with our own patients, that
people who follow such a regimen will have an easy bowel movement daily,
and will thus avoid those dangers which are connected with the habitual
use of laxative drugs.
For those who, in spite of such a course of diet, have sluggish bowels,
we recommend massage and electricity, and also certain hydrotherapeutic
procedures. The method of carrying out such must be obtained from the
special hand-books written for that purpose; but we would merely mention
here that massage should preferably be performed by one belonging to the
medical profession, or, at any rate, by one trained in the Swedish
system.
Electricity may be applied by either galvanic or faradic current, both
of which give excellent results.
Hydrotherapeutics must not be overdone or harm may result. We find that
a compress of lukewarm water (Pressnitz compress) worn round the abdomen
and back through the night, produces good results in many cases, if the
diet is, at the same time, appropriate.
For those who only suffer occasionally from constipation, as, for
instance, after a railway journey, it is an easy and always efficacious
method (if there is no inveterate constipation) to take a suppository of
glycerine and introduce it into the rectum. After only ten to fifteen
minutes interval there may be a copious evacuation.
In persons where the dietetic and above-mentioned mechanical remedies
have not proved effective, irrigation of the rectum and intestines
should be employed. We would not, however, advise the constant use of
this method, as torpidity of the intestine might result if practiced
daily (see chapter on the hygiene of the intestines).
In cases where there is a more serious degree of constipation a little
soap, or olive or castor oil, should be added to the water, together
with a little soda to assist the formation of an emulsion.
Enemata possess the advantage of having nothing to do with the stomach,
and thus this important organ can be spared much irritation which,
unfortunately, cannot be avoided when other purging remedies, such as
drugs, are given, all of which must pass through the stomach when taken
by the mouth. If we find it necessary to resort to laxative drugs by the
mouth we must first try such drugs as are least irritating to the
stomach and intestines, and foremost among these is rhubarb, which can
be taken in the form of a compote as well as a drug. To this it is well
to add magnesia and bicarbonate of soda. We should, if possible,
administer only the mildest purgatives, and, therefore, if rhubarb is
not effective, we may give cascara sagrada, or the pulp of tamarind,
which is, moreover, pleasant to take; but the action is not so
pronounced as in the case of cascara sagrada (rhamnus purshiana).
Before resorting to drugs, however, we think it would be better to try
the natural mineral waters, and only when these fail should we fall back
on drugs.
There are two kinds of mineral waters, each varying in its action: 1.
The milder acting water, of a laxative nature. 2. Stronger water, with
drastic action. Of the former we will mention those which are employed
for several weeks continuously for a regular cure: Germany: Kissingen;
Austria: Carlsbad; Marienbad. As the author of this book is himself a
practicing physician at one of these springs, he thinks it more becoming
to pass over in silence which of these waters is preferable. Each of
them, as also many others not mentioned for want of space, have their
undoubted merits. A teaspoonful of Sprudel salt, taken in a glass of
lukewarm water in the morning on an empty stomach, will give excellent
results; but it should not be taken every day for any length of time, as
otherwise, as with all other drugs if taken continuously, it may deaden
the excitability of the nerves of the intestines, and success depends
upon keeping these nerves in such a condition that they may respond,
upon a light stimulation, with a contraction of the intestinal walls and
expulsion of the fæcal matter.
Of the strong mineral waters with drastic action, there are several
excellent springs in America, some of them surpassing many of the
European mineral waters. In Europe there are in Hungary: Hunyadi-Janos,
Ferencz-Jozsefforrás, etc.; Spain: Rubinat, Villacabra-Loeches, etc.;
and elsewhere a number of such springs. As all are natural remedies they
should be used in preference to drugs when the intestine does not
respond to mild laxatives and a strong whip is needed. In my opinion
they are less fitted for every day treatment, though well adapted for a
thorough cleaning out of the intestine to get rid of stagnant matter
(see Chapter XIX).
These strong, drastic, natural waters act by causing a transudation into
the intestine, creating a condition somewhat similar to a catarrh, but
in a more benign way.
Briefly, the best and most rational treatment of sluggish bowels is by
stimulating the intestine by means of an appropriate diet which, at the
same time, tends to ward off old age.
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CHAPTER XIX.
HYGIENE OF THE INTESTINES.
AS the means by which we are able to keep the intestines in good working
order are of the same efficacy also for the stomach, all that is
necessary to mention in this chapter about the intestines will apply
equally to the hygiene of the stomach. The same applies also to the
pancreas, so that it is unnecessary to treat of its hygiene separately.
It is also our intention in this book to mention only the hygiene of
those organs which are able to rid the body of toxic products, as it is
mainly by their degeneration that premature old age is brought about.
There is scarcely a serious disorder of the stomach without an attendant
alteration of the intestinal functions. All the different agencies that
are dangerous to the stomach will also prove dangerous to the
intestines. We have mentioned several of these in the chapter on food
and the hygiene of eating, where we have pointed out that defective
mastication is very deleterious. Food introduced into the stomach passes
into the intestines, and if it reaches these insufficiently masticated
it will present great difficulties for the penetration of the intestinal
ferments. Not only will it not be well digested, but as the different
ferments cannot well penetrate these compact masses they will putrefy,
thus considerably increasing the natural fermentation, in consequence of
which a great amount of toxic products and a considerable irritation of
the intestinal mucous membrane will result, which may subsequently cause
disease. By thoroughly masticating everything we eat, we are not only
safeguarding the condition of the stomach, but also that of the
intestine.
The integrity of the functions of the intestines is of supreme
importance, for it is here that absorption and assimilation of most of
our food occurs. If our intestines are not in perfect order we shall
soon waste and dwindle away, even within a short period, and sometimes
very rapidly. Thus if we wish to retain our strength we must treat the
intestine with the greatest care. This is especially the case in old
age, for then an atrophy of the glandular mechanism of the digestive
tract, stomach, and intestines, takes place. Thus old people will not be
able to assimilate nourishment to the same extent as younger ones; they
will lose a portion of its nutritive value, and it will become more and
more difficult for them to completely digest their food. To such people,
therefore, it will be necessary to give food in a form that is easily
absorbed, preferably in liquid form; it would also be desirable to give
them their albuminous food in a predigested and soluble form. In
Germany, especially, are used a considerable number of so-called
“Nährpräparate,” a nutritive preparation which contains albumin in the
form of albumose, which naturally can be assimilated easier; there are
also carbohydrate preparations in which the starch is transformed into
dextrin or maltose. There is a legion of such preparations, but it would
lead us too far to enlarge on them by a longer description. They are
produced from proteids, many of them from fish, or from blood, or from
eggs; also from milk; while others consist of finely ground preparations
of wheat, oatmeal, barley, rice, arrowroot, sago, tapioca, buckwheat,
Indian corn, etc. As aged persons have greater difficulty in
assimilating in their intestines and stomach food in its natural state,
the use of the best of these predigested preparations would certainly be
advisable in order to insure a healthy condition of the intestines and a
prolongation of life. The last mentioned carbohydrate preparations
possess also the great advantage of preventing an excessive putrefaction
of the intestinal contents with its harmful consequences, which tendency
is always greater with albuminous food, starchy foods in large quantity
tending, as already stated, to produce acid fermentation in the
intestines by which many products of albuminous digestion can be
destroyed. Against these poisons formed in the intestinal tract we
possess a natural defense in certain ductless glands, the thyroid and
liver, which are degenerated in old people; therefore carbohydrate is
the best for them.
The prevention of intestinal putrefaction is, however, equally important
in younger people. As Combe proves, we can avoid this by the use of
certain kinds of food, especially carbohydrates and fruit, and by other
substances producing lactic acid, which is, indeed, the best
disinfectant for the intestines. The great benefit of various kinds of
sour milk generally has been pointed out by Metschnikoff and his
disciples. Among the causes of old age this savant attributes an
important rôle to the processes of putrefaction in the intestines, and
to avoid this he recommends the use of a certain kind of sour milk
produced by fermentation by a number of microbes, including the
Bulgarian _Bacillus maya_.
That certain kinds of food exercise poisonous effects when introduced
into the intestines is a matter of common observation. Thus, in not a
few cases, fever, accompanied by cutaneous eruption, may be witnessed
after partaking of strawberries or oysters, and especially after eating
meats (notably sausages) which are in a state of decomposition. Severe
cases of poisoning, even resulting in death, have occurred; and in
Germany there have been, from time to time, regular epidemics after
partaking of sausages in the above condition.
Of course everyone partaking of such poisonous food will not become
poisoned as this is prevented by the action of such glands as the
thyroid and liver, whose function it is to preserve us from such
effects. People in possession of healthy sensory organs,—eyes, nose, and
tongue,—will be enabled to tell whether meat is in a fit condition to be
eaten or not; but frequently we cannot discover by our senses a state of
decomposition when such is not in an advanced stage, and if such food is
taken regularly and in large quantities the great number of microbes we
thus introduce into the intestines will poison us slowly but surely.
Such poisonous microbes thrive and multiply very well in the alkaline
contents of the intestines, but the growth of such dangerous bacteria
can be greatly hindered by the introduction therein of acid substances,
especially lactic acid. It has been observed by several authorities,
such as Grundzach,[213] Schmitz,[214] and Singer,[215] that lactic acid
decreases intestinal putrefaction, and also the conjugated ether
sulphates in the urine.
Footnote 213:
Grundzach: Zeitschrift für klin. Medicine, p. 79, 1893.
Footnote 214:
Schmitz: Zeitschrift für Physiologische Chemie, vol. xix, 1897.
Footnote 215:
Singer: Therapeutische Monatshafte, p. 441, 1901.
Professor Metschnikoff, of the Pasteur Institute in Paris, deserves
great credit for having insisted on the importance of introducing
certain microbes into the intestines for the purpose of transforming the
sugar of their carbohydrate contents into lactic acid, and thus causing
the disinfection of the intestines by destroying the noxious germs and
hindering their development. For this purpose the so-called Bulgarian
bacillus can best be employed, as it is able to transform the cultures
of pathologic microbes in the intestines into a beneficient growth that
is quite harmless.
This Bulgarian bacillus is well known because of its action in producing
the sour milk “yoghurt” of the Bulgarian population, to the use of
which, according to Metschnikoff, is due the very large number of
centenarians to be found in that country.
The action of the lactic bacilli has been proved by the experiments of
Dr. Herter, of New York,[216] who discovered that by the introduction of
large quantities of these bacilli into animals their intestinal
putrefaction was diminished.
Footnote 216:
Herter: Brit. Med. Jour., p. 1898, Dec. 25, 1897.
Dr. Michel Cohendy[217] has performed similar experiments on himself.
After taking for twenty-five days his usual diet and subsequently noting
the degree of his intestinal putrefaction, he took pure cultures of a
lactic bacillus, extracted from “yoghurt.” For more than two months he
continued to take large quantities of these bacilli (280 to 350 grammes
a day). Not only during the course of the experiment did the urine
exhibit evidences of a diminution of intestinal putrefaction, but this
continued for seven weeks afterward, and he arrived at the conclusion
that the lactic acid fermentation due to this bacillus was able to
hinder the putrefying action of the microbes developed from the meat he
had taken during his experiments. He, therefore, comes to the conclusion
that it is unnecessary to discontinue meat food for the suppression of
intestinal intoxication if lactic bacilli be taken therewith.
Footnote 217:
Cohendy: C. R. de la Société de Biologie, Mars 17, 1906.
Dr. Pochon, assistant to Professor Combe, of Lausanne, continued upon
himself the experiments of Dr. Cohendy. For several weeks he took sour
milk (lait caillé) which was prepared from cultures of pure lactic
microbes, and he found positive proofs of the checking of intestinal
putrefaction thereby.[218] In those, therefore, who are able to procure
and use a pure preparation of lactic bacilli, intestinal putrefaction
will be greatly diminished. But even when we cannot obtain these
preparations we can follow a diet that will tend to develop lactic acid
fermentation. This can be brought about by taking carbohydrates in large
quantities, especially those which are very rich in sugar, at the same
time taking milk, particularly sour milk.
Footnote 218:
Combe: “L’Auto-intoxication intestinale,” Paris, 1906.
It is an absolute fact that in those who are addicted to a diet of
carbohydrates, intestinal putrefaction is diminished, owing to the
formation of lactic acid from the fermentation of the milk-sugar which
is contained in such carbohydrates.
Intestinal putrefaction is enhanced by the alkaline contents of the
intestines; it can, therefore, be checked by various agencies that
diminish the alkalinity of the intestine, such, for instance, as by
lactic acid, just referred to. Fatty and acetic acids also effect this;
likewise fatty food, which promotes the formation of fatty acids. Cheese
may produce fatty and also lactic acids; wherefore it is of value to
combat putrefaction in the intestines. Of the further benefits of cheese
as an article of food, we make mention in the chapter on the hygiene of
food; we also state there that it is unsuitable in those cases in which
the intestines are not in thorough order.
Great care should be exercised in the quality of the food. The freshness
of various foods is of the greatest importance to the intestines, since
the main function of the stomach is principally a mechanical one,
serving to reduce the food into a convenient form and carry it to the
intestines, ready to be there prepared, through the influence of the
intestinal juices, into a condition fit for absorption and assimilation.
During this process the food is being reduced to its simpler elements,
and the more noxious substances are being freed to commence their
baneful activity. These substances first of all create an inflamed
condition of the intestines; then, being absorbed into the blood, they
cause a general intoxication. Fortunately they are not frequently
absorbed, and thus their injurious effect is limited to the intestine.
Among other such injurious foods we may mention fish and oysters,
sausages and meats that are in a state of decomposition; fruit that is
unripe or unsound; and canned food in which certain drugs are used as
preservatives, such being poisonous in varying degree, examples being
salicylic boracic, and sulphuric acids, etc., and at times even the
terrible poison, verdigris. Fresh food should always be preferred to
canned food, or to food preserved in other forms for too long a period
(see also chapter on the hygiene of food).
The stomach, and intestines also, can frequently suffer damage from ice
cold drinks, especially if taken habitually and in large quantities. As
already mentioned in the chapter on the hygiene of the kidneys, we
should never forget that every sort of food or drink must pass a series
of delicate epithelia of our noblest organs, which can be injured by
sharp and poisonous substances with which they come in contact.
More injurious is the action of various kinds of noxious food,
especially if putrid, which remain for a long time in the intestines,
thus creating a chemical laboratory constantly preparing poisons. Even
the residue of less harmful foods, especially albuminous, even if of
good quality, when taken into the body, can become deleterious if it
remains too long in the intestines. It will, therefore, be a part of the
highest wisdom to exercise care in having these highly important organs,
on which all our nutrition depends, in thoroughly good working order by
keeping them clean and by removing stagnant material. We have already
designated the best way to effect this in a previous chapter, and we
desire here to say a few words on the abuse of, and great dangers
arising from, remedies constantly prescribed for constipation.
We have insisted in the foregoing pages on the necessity of a daily
bowel movement, and have stated that appropriate food is the best way to
attain this. Food that leaves no residue, like meat or finely ground
cereals, is incapable of producing a stool. Hence, as Schmidt has
pointed out, constipation is often caused by the food being too
completely absorbed. Strassberger, by analyzing and counting the number
of bacteria in the stools, found that certain cases of constipation were
caused by a diminished fermentation in the bowels. Lohrisch has found
that in persons whose intestines possess a marked power for absorption
there does not remain in them a residue sufficient for the action of the
bacteria, and thus there will not be a sufficient fermentation to act as
a stimulant to the intestinal walls to cause them to expel their
contents. Uncooked cold milk (especially buttermilk, whey, sour milk,
“yoghurt,” kefir, etc.), and dishes containing vegetables and fruit,
grapes, puree of prunes, marmalade of oranges, and brown bread (Graham,
Pumpernikel, etc.) should produce a movement of the bowels every day in
a normal man or woman. There are, however, many exceptions to this,
especially in the case of women, caused either by previous errors in
diet, or by negligence in answering at once the demands of the bowels
for an immediate evacuation, and also, very often, by an abuse of
purgatives. All this is, of course, aggravated in those in whom the
innervation of the bowels, which is controlled by the splanchnic nerves
and the vagus, is altered by the degenerative condition of certain
glands which influence these nerves: the sexual organs and the thyroid.
These alterations are far more common in women, as frequently mentioned
before, as their sexual glands and thyroid are so often irritated by
physiological and pathological processes peculiar to her sex, and which
so frequently recur during the life of a woman. It is a fact that most
of the diseases of the female sexual mechanism are followed by
alterations in the intestines, due, in part, to their close proximity to
the pelvic organs, but, in a greater degree, to the intimate relation of
these regions to the nerves that control the intestines. The same is
true to a lesser degree in man, so that after troubles with the
prostate, or after chronic gonorrhœa, a regulation of the bowels is an
important matter, constipation being usually very obstinate in such
cases.
In addition to this sluggishness of the bowels in females, owing to
anatomical and physiological causes, there may be associated faults
arising from a bad habit. Instead of paying special regard to the innate
tendency toward constipation and endeavoring to have a movement every
day, many women, especially young girls, neglect this by even resisting
the demand of the intestine to be evacuated, and deferring this most
important function to the following day, or even later. Such a course
necessarily lowers the vitality of the intestinal nerves and muscles. As
soon as such a nervous impulse is felt, we must promptly act on it;
should we not do so a greater nervous and muscular effort must follow,
and, if even then we neglect to obey the call of Nature, after several
such useless efforts the nerves and muscles of the intestines will
relax, particularly if such a foolish practice be often repeated, for it
is quite natural that such an intestine will not respond to the
stimulation by the pressure of its contents upon the nerves, and its
muscles will not contract to expel the fæcal contents, as in normal
people.
Unless, therefore, from force of circumstances, it is impossible, we
must at once respond to the first admonition of the intestines, and not
exhaust the vitality of its nerves and muscles by exposing them to
unnecessary efforts at our own expense. Some people are so impressed
with the importance of immediately answering such a call that they will
forego the most urgent business on that account. I know an authentic
case of a member in the profession—a great surgeon—who, a few years ago,
was urgently summoned to a member of the highest nobility who had met
with a hunting accident. Unfortunately for the patient the call came at
just such a moment as we have been speaking of; true to his principles,
he did not arrive immediately, but only after having fulfilled the
execution of this important part of the hygiene of his intestines, and
the patient lost his life.
Happily such an instance is of the rarest occurrence in our profession,
for we always ignore our own chance for a long life in favor of our
patient’s, which is fully proved by the fact that, of all professions,
the physician’s life is the shortest.
Corsets as worn by women contribute to develop in them ptosed
bowels—gastroptosis and enteroptosis—which can easily arise after
pregnancy; the strength of the intestinal muscles becomes still more
diminished and constipation is the consequence.
It is not to be wondered at if women, and men also, in cases where the
diet alone does not bring about an ordinary movement, should resort to
drugs, several of which we have mentioned previously. At first, even the
mildest drugs will act; but, unfortunately, after a time the intestine
becomes accustomed to them and they cease to act. Stronger drugs are
then resorted to, such as often contain aloes, which, besides injuring
the stomach, act in a very irritating way on the intestines; these
respond by a very strong action, causing copious stools accompanied by
colicky pains. But it is in the nature of things, as we have observed
holds true in any organ, that overstimulation of any function is
followed by its exhaustion; thus the nerves and muscles of the intestine
get over irritated and relax if obliged to overact. After a copious
evacuation caused by strong drugs we, therefore, find a still more
obstinate constipation than before. Stronger and stronger drugs are then
used until there is a complete breakdown and ruin of the intestinal
innervation and muscular action. We must, therefore, commence first with
a suitable diet, then use mild drugs if necessary, with massage and
electricity, as already described.
Intestinal enemata are also beneficial, but if a large amount of liquid
be used the muscular walls get too greatly dilated and may lose their
elasticity and vitality, particularly if strong drugs be used in such
enemas.
Many women suffer from habitual constipation by reason of their drinking
but little water, especially if the food they take contains little
fluid; the fæcal masses become solid and coagulated, and thus their
passage in the intestine toward the anal exit becomes more difficult,
whereas by a sufficient quantity of liquid, such as water, this movement
will be much facilitated; and that this is an important consideration is
quite evident in the case of women who have a tendency to lethargic
bowels. Such a thickening of the fæcal masses occurs particularly in
certain parts of the intestines, such as the cæcum, the ascending colon,
and the sigmoid flexure. In these parts the fæcal matters often become
detached, accumulate, and easily get condensed. They may remain there
sometimes for longer periods, which can easily be proved by experiments,
giving bismuth by mouth and then examining the abdomen by means of the
Roentgen rays.
It thus happens that people, under the impression that a good daily
stool has produced a clean bowel, still have a residue, and this can
instantly be seen by removing the same by purging drugs. We, therefore,
recommend the weekly use of a reliable purgative, such as bitter water,
thus cleaning the bowels of all residue, which frequently remains in
deep haustra of the intestines, as in Barlow’s disease.
The stagnation of fæces around the cæcum may also facilitate the
development of appendicitis, this being frequently due to neglect of the
hygiene of the intestines. It is also one of the commonest diseases, as
we will show in the succeeding chapter.
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CHAPTER XX.
HYGIENE OF THE INTESTINES—A FEW REMARKS ON THE CAUSE AND PREVENTION OF
APPENDICITIS.
APPENDICITIS, in these days, is one of the most frequent causes of an
unexpected death. As this work is designed to set forth the means by
which we may prolong life, it is desirable not to miss the opportunity
of offering a few remarks, in connection with the chapters on the
preservation of the intestinal functions, upon the cause and prevention
of an intestinal disease by which particularly young and promising lives
are frequently cut off.
In the previous chapters we saw that the cæcum was one of the places of
selection for the stagnation of the fæcal contents in the intestinal
canal. As the pressure of such fæcal matter in the cæcum and colon is
greatest toward the appendix the contents may go more easily into than
away from the appendix, and particularly so when, from a long rest in
the cæcum, they are thickened. The return of fæcal matter from the
appendix is often hindered by a spindle-shaped thickening at the
junction of the appendix with the cæcum, which presents the appearance
of a narrow bridge.
This thickening of the mouth of the appendix is the consequence of the
very close contact of the psoas muscle, upon which, in many people, the
appendix lies, so to speak resting upon it. This has been shown by
Offerhaus[219] (a surgeon in the Hague Hospital) to be the case in 62
per cent. of normal men.
Footnote 219:
Offerhaus: Proefschrift, “Eine mechanische oorzaak voorhet ontstaan
van Appendicitis,” Leiden, 1901.
In certain movements, such as running or cycling, the psoas is
continually pressing against the appendix, and it is natural that such
continuous pressure against this organ will in time leave a permanent
mark, which is, indeed, seen in many cases of appendicitis. After a
certain time a circumscribed segmentation will be visible on the parts
of the appendix which are in contact with the psoas, and later this
becomes so marked that a circular kinking results, establishing the
narrow bridge to which we have already referred.
It is logical that the thicker the appendix, the more pronounced will be
the marks produced by the pressure of the psoas. The average size of the
appendix, even in the adult, is that of a somewhat slender worm, from
which is derived the name “vermiform appendix.” But when there is
stagnation of the fæcal contents in the appendix, and especially when
the thickened fæcal matters are of such hard consistency that a hard
stony concrement, such as the coprolith is formed, then the appendix
sometimes assumes quite a comparatively large size. We saw the case of a
girl of 16, operated on by Dr. Offerhaus at the Hague (details of which
case were published by him), in whom the appendix was of the size, in
circumference, of a large thumb.
In such large appendices the marks of the psoas will, of course, be more
pronounced, and frequently the narrow bridge referred to will develop.
This is caused by the appendix being further attached to the intestines
where, owing to the narrow connecting bridge, it is unable to evacuate
itself, and so grows larger and larger, the mischief thus constantly
increasing.
It is also evident that the nutrition of an organ whose blood-supply is
mechanically interfered with, as in the case of the appendix by its
close contact with the psoas, as described above, must necessarily be a
precarious one; and it is a pathological fact that an organ which is
badly supplied with blood is also more liable to disease, because the
insufficient supply of blood causes a diminution in the number of
phagocytes thereby weakening the defense of the organ against infection,
as explained in Chapters III and X. Consequently the microbes easily
prevail, particularly in a portion of the body like the intestines,
where they normally exist in such great numbers.
By the foregoing we have not only shown the cause, but also the
principles for a rational prevention, of appendicitis. As we have seen,
the starting point of all mischief is the close proximity of the psoas
to the appendix, and the occasional cause is constipation, with
stagnation of the fæcal contents. The best preventive against
appendicitis consists in avoiding both causes, which, however, is only
possible in the latter case by adopting all those measures we have
mentioned in the chapter on the treatment of constipation.
The first cause, the close contact of the psoas with the appendix, can
certainly not be prevented; but what we can do is to avoid all movements
by which the psoas is unduly pressed against the appendix. This can be
done by avoiding those exercises in which the psoas is brought into
frequent contraction and then pressed forcibly against the appendix: for
instance, running, cycling, etc. The young lady, already referred to,
with the large stone in the appendix, indulged freely in such sports.
The habit of sitting with one leg crossed over the other should also be
avoided.
We must now, however, determine who those persons are in whom such a
condition exists. They are those who frequently complain of pains in the
appendicular region, usually after quick walking or running, and
especially after cycling, and at times even without these; but in this
latter class the pain is milder. In order to make an exact diagnosis
whether such pains are caused by pressure of the psoas upon the
appendix, we must tell the patient to lift the right leg high and we
then press with the right hand against the thigh. If there is a latent
form of appendicitis due to the above-named anatomical relations, then
the patient will experience pain when we press with the left hand upon
McBurney’s point. By this means appendicitis can be diagnosed while it
is still in an early stage, and the life of many may be saved before it
is too late, and we know only too well how rapidly this treacherous
disease can lead to a premature death.
Having made the diagnosis in the above-mentioned way, we should prohibit
all active movements, especially running, cycling, etc., and take
special care to have a daily bowel movement by the use of a suitable
diet and those other means previously mentioned.
Pain in the appendicular region may be of a very pronounced character,
and yet there may be no appendicitis, for it may be caused by
inspissated fæces. The presence of stagnating fæcal matter often induces
the formation of gas, and by the distention so caused the intestinal
nerves are irritated and thus pain occasioned.
We can distinguish between appendicitis and pains following colics,
caused by flatulency, by giving carminatives, such as the decoction of
different carminative herbs called Aqua Carminativa Regia, which is much
used in Germany and Austria, where it is an official preparation of the
Pharmacopœia Austrica and Germanica. A few tablespoonfuls of this
decoction will produce free passage of gas, after which, in the case of
flatulent colic, the pain will disappear, especially if we add a
purgative and clear the intestines. Of course, in appendicitis the pain
will not disappear after the use of carminatives.
Besides the foregoing very frequent causes of appendicitis there are a
few others to deal with, all of which here is out of the question; our
intention is to confine ourselves to mentioning some of the more
frequent causes and not to deal exhaustively with the subject, which can
be found in the various hand-books on surgery. Yet we should like to
mention one cause that is not infrequent, and this deals with the
relation between the tonsils and the appendix. If we examine these
organs histologically, we shall find that both are of the same lymphoid
tissue, and, indeed, some writers go so far as to term the appendix the
tonsil of the intestine.
Now we can often observe that when one of the lymphoid structures is
changed, the others may follow; and this shows that just as the ductless
glands are in close relation to one another, so also the ductless glands
and the lymphoid structures stand in close mutual connection, as we have
mentioned in previous works, emphasizing the fact that the tonsils are
often much enlarged in myxœdema, Graves’s disease, acromegaly, diabetes,
etc.
In addition to these intimate relations there are also other causes
arising from the tonsils that affect the appendix. Such is the case when
the tonsils are inflamed and infectious matter arising therefrom reaches
the intestines. The cause of appendicitis from such a source has been
confirmed by the bacteriological examinations of Professors Lanz and
Tavel. Indeed, clinically, we can often see that appendicitis has been,
in quite a number of cases, the result of previous tonsillitis, this in
turn often being caused by the secretion from the inflamed posterior
part of the nose coming in contact with the tonsils, as has been
previously stated.
Very frequently such a condition exists in conjunction with adenoid
vegetations, and this explains the error into which Delcour has fallen
in his book on the relation of adenoid vegetations to appendicitis, in
which he attributes the immediate cause of the latter to a state induced
by an insufficiency of the thyroid gland. We can often observe that
adenoid vegetations can exist with a good thyroid and _vice versâ_,
although we cannot deny the fact that in children with thyroid
insufficiency adenoid vegetations are frequent.
It is very probable that the first mentioned causes of appendicitis and
the last named often go together, the one assisting and developing the
other. The unfavorable anatomical position and constipation, together,
offer a very favorable soil in which, through bacterial co-operation
after tonsillitis, influenza, or other infectious diseases, this much
dreaded disease can develop.
By a slight operation life is often saved. The pity is that such aid is
often invoked too late.
------------------------------------------------------------------------
CHAPTER XXI.
ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE KIDNEYS.
IN the course of this work we have frequently insisted on the fact that
we are being continually poisoned during the processes of life, either
by poisons coming from without into our body through food or drink, or
by toxic substances being formed in our body through defective
metabolism. We have a series of glands with internal secretions which
have properties antagonistic to these poisons, the most important of
such glands being the thyroid, parathyroid glands, adrenals and the
liver, which act by destroying these injurious products.
The following can now happen: Either these toxic products may be
produced in such enormous quantities that even the increased functions
of these glands will be insufficient to overcome them, or the glands may
not be in a condition of complete integrity. In either of these cases
the bulk of these poisons will be carried to the eliminating organs to
be dealt with, viz.: the skin, the intestines, and the kidneys.
As we shall see, the skin alone is not able to eliminate more than a
certain portion of these products, even by the additional assistance of
perspiration. In addition to the skin the intestines may also assist the
work of the kidneys, by expelling principally the poisons from the
digestive organs. But only a small portion of the poison circulating in
the blood will be eliminated in this way, especially if there is a lazy
action of these organs. Thus the great bulk of all these products is
carried to the kidneys, which are, indeed, our most important organs for
the elimination of toxic products from the blood.
It is furthermore important to consider the kidneys because they are
also glands with internal secretion. This is evident from the fact that
uræmia is a condition which is dependent upon the absence of such a
secretion.[220] It is not caused only by the retention of urine and the
urea contained therein, for cases have been noted where there has been
no urine for as long a time as seven days, and yet there was no uræmia,
whereas uræmia rapidly develops at times in spite of an abundant flow of
urine and elimination of urea. Thus, logically, uræmia must be ascribed
to another factor, which can only be the absence of an internal
secretion from the kidneys, which may otherwise perfectly perform their
work. Another convincing proof of this statement is the fact that we are
able to treat with great effect, as we have personally observed,
diseased kidneys with extracts from the kidneys of pigs. We will
demonstrate the action of this in a separate chapter.
Footnote 220:
Senator: Loc. cit., and others.
That the kidneys are glands with internal secretion has been proved
already by Brown-Séquard,[221] Meyer,[222] and other authors, among whom
we will mention as two of the last authorities on this question,
Professor Senator and Professor Hermann Strauss.
Footnote 221:
Brown-Séquard: Archives de physiologie norm. et path., p. 778, 1893.
Footnote 222:
Meyer: _Ibid._, p. 179, 1894.
The kidneys, being glands with internal secretion, must then stand in
close relation to the other ductless glands, according to the law
established by us in our previous works. As already mentioned, we have
shown in a communication to the Paris Biological Society, February 25,
1907, that these glands have an intimate relation to the thyroid gland,
and _vice versâ_. Thus, alterations of the thyroid always produce
changes in the condition of the kidneys. These alterations in the
kidneys may, however, not necessarily be based on the intimate relations
between thyroid and kidneys as ductless glands, but may be produced by
the fact that, when the thyroid is degenerated and cannot destroy toxic
products, these poisonous matters will be thrown on the kidneys (the
skin and intestines not being of assistance under such conditions) and
eliminated by them. Naturally the passage of such poisonous products
through the kidneys is liable to produce changes in them, and
albuminuria and hyaline or granular casts may show themselves in
consequence.
The same may also happen after changes in the liver. When this important
organ is not able to destroy poisons they are carried in increased
quantities to the kidneys, whence their passage will produce albuminuria
and hyaline and granular casts, as has been especially described by such
French authorities as Huchard, Teissier of Lyons, Molière and Gouget,
etc., as occurring in diseases of both liver and gall-ducts.
The appearance of albuminuria, and even of hyaline casts, must be taken
as a proof of an abnormal condition of the kidneys, and this
notwithstanding numerous authorities who are inclined to regard such an
occurrence in a more lenient way. We hold, with Professor Senator, that
the permanent presence of such elements in the urine is the proof of the
fact that the kidneys are not in a normal condition. Even the
orthostatic albuminuria of quite healthy persons, which, as its name
implies, only occurs when such persons have been standing for a time in
an upright position, has been considered by Senator as an expression of
the existence of certain changes in the kidneys. According to Senator,
the hyaline casts also are not such an innocuous symptom as certain
authorities claim, but they are formed from the degeneration of the
convoluted tubules. This is the most important element of the kidneys,
for the greater part of the solids and toxins are excreted by its cells
from the blood, and besides this function these epithelial cells also
have an internal secretion. The appearance, therefore, of hyaline casts
(which, as Senator found, could be proved under the microscope as having
been formed through degeneration of the epithelial cells) must be
considered as evidence of the loss of the secreting portion of the
kidneys and of the destruction of their most important elements, and can
be found regularly in all the toxic processes that take place in the
body, showing that the poisonous products of these processes have passed
through the kidneys and been eliminated.
Thus we find albuminuria and casts, and even signs of a serious
inflammation of the kidneys, in different infectious diseases, and even
after tonsillitis; also after other toxic conditions caused by the
secretion of toxic products in the body from certain ductless glands,
such as the sexual glands during puberty and the thyroid gland in
Graves’s disease. Likewise in certain diseases where waste products of
metabolism cause uric acid to be formed in large quantities, as also in
diabetes, where a quantity of other toxic products, besides uric acid,
are produced.
From the foregoing it is only natural to expect that different toxic
products which are introduced into the organism from without, either in
the food or in the drink, or which result from the decomposition of meat
and alcohol and other stimulants, will also, for the most part, be
eliminated by the kidneys, especially with a dilatory performance of the
other disintoxicating organs. When passing in large quantities, or
sometimes even in smaller numbers, they may be able to irritate the fine
epithelia of the tabula epithelia and also those of the glomeruli, and
produce casts (hyaline ones especially) and albuminuria. After large
quantities of alcohol such a condition can even become permanent if the
other toxin-secreting organs are sluggish.
In his experiments on animals Penzoldt has produced albuminuria by means
of English mustard, pepper, and particularly radishes, and still more so
after black tea. Gunzburg noted this also in a boy of 13, and Roth in a
child of 3½, in both cases after the use of black tea.
Albuminuria and casts can frequently be observed after the
administration of drugs in degrees varying according to the toxicity of
the drugs. We have published a case in which even epithelial cells of
the kidneys, single and in casts, as well as blood-casts in quantities,
have been found after an administration of chloride of potassium. Luttje
found casts in 33 cases out of 207, and in 92 of these albuminuria,
after the administration of salicylates, and he issues a warning against
their continual usage. That the same occurrence has also been observed
after the use of other poisonous drugs such as mercury, chloroform,
etc., will only appear to us as natural.
The skin and intestines, which co-operate continually with the kidneys,
are able to do a part of the work of the latter by eliminating poisons
which otherwise would have been carried to the kidneys, injuring the
delicate structures by which they are secreted and through which they
pass. As will be found in the chapter on the functions of the skin, this
tissue is able to eliminate (especially when its functions are
increased, as in cases of perspiration) a part of the harmful products,
among them being some of the nitrogenous end-products of metabolism, and
also common salt. But when the skin is unclean and its pores are clogged
by dirt and the products of perspiration, and when it is diseased, as in
skin diseases, or when it is burnt extensively and the sudorific glands
destroyed, then these poisonous products are directed to the kidneys,
whose secreting structure will naturally be injured by their passage.
The same may also happen after an obstruction or hindrance to the
intestinal functions. When the passage of fæcal matter is retarded for a
long time, a re-absorption of toxic matters can take place by the blood,
necessitating their elimination by the kidneys, with harmful
consequences to these important organs. This has been proved by
experiments made by Wallerstein, who mechanically closed the anus of
rabbits and dogs. After but twenty-four hours he found albuminuria and
different kinds of casts in the rabbits’, and casts only in the dogs’
urine. It is very important evidence in favor of our supposition that
the convoluted tubules of the kidneys play the most important part in
the excretion of harmful products from the blood, that Wallerstein
found, after four days, that the greatest change had occurred in the
convoluted tubules of the kidneys in these animals. The epithelial cells
of these tubules were greatly degenerated and in a state of coagulation
necrosis.
Similarly English[223] has found albuminuria and casts in cases of
strangulated hernia in men, in consequence of the stagnation of the
contents of the intestines and the re-absorption of toxic matters.
Similar results may also occur according to Leichtenstein, Senator,
Jaffé, etc., in cases of intussusception, incarceration, and similar
pathological conditions.
Footnote 223:
Oesterr. Med. Jahrbuch, No. 2, 1884.
Thus we can all easily understand how the stagnation of the intestinal
contents, as, for instance, in chronic habitual constipation, may also
be injurious to the kidneys; and, indeed, Kobler and Huler have
described albuminuria as a consequence of constipation. Not only is the
elimination of excrementitious substances checked, but there is
re-absorption of poisonous products from the intestinal contents which
the kidneys must excrete.
That poisonous products coming from the intestinal tube are apt to
produce even serious changes in the kidneys has been proved by Heller
and Fishel after catarrhs of the stomach and intestines. At the same
time we will also mention that in cases of intestinal auto-intoxication
we can also observe a diminution in the quantity of urine, as noted by
several authors, of whom we specially mention Boas and Hemmeter.[224]
Footnote 224:
Hemmeter: Loc. cit.
From the foregoing there can be no doubt that most of the toxic products
in the blood are eliminated by the kidneys. This is also the manner in
which the nitrogenous end-products of metabolism leave the body. The
kidneys act as a kind of filter for these products. When the kidneys,
however, are changed or degenerated by the formation of connective
tissue and loss of the elements of excretion, as in old age, then these
products will be retained in a greater or smaller number, and a
condition of auto-intoxication follows, to which we have previously
ascribed a great rôle in the pathology of old age. Logically, if we wish
to prevent old age coming on too soon, or a diminution of our chances
for a long life, we must do our best to prevent such a diseased
condition.
------------------------------------------------------------------------
CHAPTER XXII.
HYGIENE OF THE KIDNEYS, AND THE PREVENTION OF RENAL DISEASE.
THE most rational hygiene of the kidneys for the prevention of kidney
diseases consists in the avoidance of all those causes which are
injurious to the kidneys, and which we have mentioned in the previous
chapter. A great part of the poisonous products that are eliminated by
the kidneys are introduced with the food and beverages, and it is
important for us to bear in mind the fact that what we eat or drink must
pass through our kidneys, and that the structure of these organs is
delicate; that the most important secreting parts are composed of fine
epithelium which can easily be desquamated by the passage of irritating
products. Thus we note the appearance of hyaline casts after different
kinds of spices and stimulating liquors, especially if taken in large
quantities.
There are many members of the profession who attach no importance to the
occasional appearance of a hyaline cast. But, considering the finding of
Professor Senator[225] that such casts are formed by degeneration of the
tubular epithelium, we cannot take such a lenient view; for even if we
find only one cast in two or three microscopic specimens, we must
realize how many thousands of these there may be in a liter of urine.
Thus every day thousands of these casts, and in a year enormous
quantities, may be lost. But as each cast means the loss of important
secreting elements, there can be no doubt that, after a certain time, we
shall have lost an important part of these most important organs, whose
place is taken by connective tissue. Thus the development of
interstitial nephritis can be hastened by faults in our alimentary
régime. In cases where meat is taken abundantly it is most probable that
the continual excretion from the blood of nitrogenous end-products of
metabolism means a serious overwork for the kidneys and grave damage to
their epithelium. And still more so if, owing to a diminished activity
of the liver due to senile degeneration, toxic products of a higher
toxicity than urea, and even uric acid, are passed.
Footnote 225:
Senator: Loc. cit.
We have observed the great frequency of albuminuria and casts in the
urine of persons who were addicted for many years to a plentiful meat
diet. According to Dr. James Tyson,[226] who has been for many years
making accurate observations on diseases of the kidneys, and who has
published a standard work on them, interstitial nephritis can be
produced after the prolonged ingestion of much meat. If we wish to keep
our kidneys in the best condition, a lacto-vegetarian diet with only
little meat, once a day, is the most suitable. Still more than meat,
bouillon and meat gravies should be avoided, since they contain
irritating meat extracts.
Footnote 226:
Tyson: A treatise on “Bright’s Disease and Diabetes,” second edition,
London, 1904.
Milk diet in abundance is not only indicated in liver disease, but also
in chronic kidney troubles. But when there are coexisting changes in the
circulatory system, milk should not be given in large quantities, but in
smaller amounts. Milk has also the great advantage of being a strongly
diuretic substance, especially in its acidulated forms (yogurth or
kefyr, or simple sour milk); and at the same time it irritates the
kidneys very little, since it contains only a minute amount of common
salt.
According to Bunge, we take decidedly too much salt every day, and in
this way we injure our kidneys considerably. Achard,[227] Strauss,[228]
Vidal and Javal,[229] and simultaneously H. Strauss, have found that
diseased kidneys (especially in acute or chronic parenchymatous
inflammations) are unable to eliminate sodium chloride properly, and its
retention leads to œdema. According to these authorities, œdema is
caused by a retention of water and sodium chloride, the retention of the
latter playing the primary rôle, whereas according to Alexander Koranyi,
Richter, Kovesi, and Roth-Schulz, the retention of the water is the
primary factor.
Footnote 227:
Achard: Presse méd., 1901.
Footnote 228:
Strauss: “Die chronischen nierenentzundungen,” Berlin, 1902.
Footnote 229:
Vidal et Javal: Soc. Méd. des Hôpitaux, Juil. 31, 1903.
For these reasons salt should only be taken in very small quantities.
Alcohol should also be avoided, except in small quantities, as being
very injurious to the kidneys; and considering that chronic nephritis
may be caused by the immoderate use of alcohol, Bunge thinks that the
chronic nephritis following large quantities of alcohol may be
attributed to the fact that, according to the researches of Keller,[230]
made in Bunge’s laboratory, the alcohol habit leads to an immoderate use
of salt with its deleterious effects upon the kidneys.
Footnote 230:
Keller: Zeitschrift für Physiol. Chemie, vol. xiii, p. 130 and 134,
1889.
According to Bunge, rice gives very little work to the kidneys, as in
twenty-four hours only 2 grammes of alkaline salts are eliminated. On
the other hand, potatoes cause a very great elimination of salt by the
kidneys. Bunge thinks that rice would be a good food for patients with
renal disease.
Not only alcohol, but other stimulants, like tea, can be of harm to the
kidneys if taken in large quantities, as we have mentioned in the
preceding chapter when speaking of black tea.
We do not think, however, that the daily use of black tea, in moderate
quantities, would have unfavorable effects on the kidneys. Its relation
to the production of uric acid should, however, be remembered (see
chapter on other stimulants: coffee, tea, tobacco, etc.).
For reasons already mentioned, irritating spices and adulterated sauces
should be very carefully avoided; also all kinds of food which contain
pungent ingredients. We have no doubt that by their use life is often
shortened. The passage of such poisonous substances for years through
our kidneys must injure their delicate structure and hasten the
development of the senile kidneys, with interstitial nephritis.
It is advisable to drink plenty of water, especially when much meat, or
the above-mentioned sauces, are eaten. By this means we can flush out of
our kidneys the end-products of proteid food, and also other toxic
substances. For the same reason it is well to use certain mineral waters
with diuretic properties. They should, however, not be taken at the same
moment as substances irritating to the kidneys are taken, or the kidneys
may be so injured that acute hæmorrhagic nephritis may ensue. We[231]
have published such a case, where even small quantities of chloride of
potassium taken on an empty stomach, together with Wildungen waters,
which have very diuretic properties, provoked a condition of acute
nephritis, with great quantities of blood clots, epithelial and granular
casts, many epithelial cells, and red and white blood-corpuscles in the
urine.
Footnote 231:
Journal méd. de Bruxelles, 1903.
When taking various drugs, we must always remember that they must pass
through our kidneys. The drug habit, especially when irritating drugs
are taken, can have a ruinous effect on these vital organs and surely
diminish our prospects for a long life. Day by day many of the
epithelial cells will be desquamated, slowly but surely, and
inflammatory conditions of the kidneys will eventually appear. There is
nothing in this world without a cause, and if a chronic parenchymatous
or interstitial nephritis suddenly appear, it must have a pre-existing
cause. It is the result of our continual neglect and abuse of these most
important organs. As Prof. Friedlich Müller said a few years ago, the
kidneys never forget the wrong they once have suffered. Indeed, most of
the evil that befalls us in this world is our own fault, for doing
things we should not do and omitting those we should.
A frequent source of renal diseases is infectious diseases with the
passage of toxic products through the kidneys. This source of kidney
disease is often overlooked, the symptoms of acute nephritis being
mistaken for or confused with those of the infectious disease. Acute
nephritis after tonsillitis is often not diagnosed unless the symptoms
are very marked. In such cases occasional casts and epithelial cells,
with red and white blood-corpuscles, may remain for a long time in the
urine, sometimes permanently, and thus slowly and insidiously chronic
nephritis develops.
Tonsillitis is often caused by the dropping upon the tonsils of mucous
secretion from a post-nasal catarrh. This is commonly so in chronic
rhinitis caused by adenoid vegetations. The best prevention of renal
diseases in these cases is operation on the vegetations and treatment of
the rhinitis, rather than removal of the tonsils, which probably play a
great rôle in the defense of the organism against infections. This is
shown by the fact that they are inflamed in the early stages of many
infectious diseases.
The greatest care must be given to the condition of the skin and
intestines, if we wish to keep our kidneys in good order and prevent
their deterioration. We must try to eliminate through the skin and
intestines as many as possible of the toxic substances which otherwise
would make their way to the kidneys and increase their work, and perhaps
injure their epithelium. In this way we can save our kidneys for their
time of need.
Therefore, the skin and intestines should be kept in good working order.
We must do all we can to maintain the function of the skin, and in
several chapters of this book we have considered this question. We will
only mention briefly that the invisible perspiration of the skin should
be encouraged as much as possible. Damp and cold weather are apt to
suppress it. In such weather our skin also gives off too much warmth,
therefore we should be warmly clad, wool, especially for old persons,
being best. Still more important is this when the kidneys are already
damaged. For such persons a warn climate is advisable. By increasing the
perspiration to sweating, products which are harmful to the kidneys may
be eliminated. Hence such procedures will take work off the kidneys and
rid them of injurious substances. The sweating should be done
frequently, at least once a week, if we want to keep our kidneys in good
condition. For fuller particulars on the hygiene of the skin, and also
of the intestines, we refer to the chapters relative to these questions.
------------------------------------------------------------------------
CHAPTER XXIII.
ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE SKIN.
THERE are some two and a half million small glandular formations—the
sudorific glands—on the whole surface of the body in the subcutaneous
tissue of the skin, from which issues a secretory tube somewhat of the
nature of a corkscrew to the external surface of the skin.
These glands are richly provided with blood-vessels, and a comparison
may be drawn, to a certain extent, between the glomerules of the kidneys
and these small glandular formations. The first receive certain
substances from the blood and give it off through the tubules which
carry away the urine, and the latter take both fluid and solid
substances from the blood and eliminate it in the form of sweat through
the excreting channels of the sudorific glands.
Gas can also be eliminated through the skin—carbonic acid—though in
infinitely smaller quantity than by the lungs, for while the latter
eliminate from 800 to 1200 grammes of carbonic acid, it has been shown
by the experiments of Aubert[232] that a human being eliminates through
the skin a maximum of 6.3 grammes and a minimum of 2.3 grammes in
twenty-four hours, which is certainly a very small quantity. Besides
carbonic acid the skin probably also eliminates other organic
combinations in the form of gas, though it would be very difficult to
analyze them by exact experiments. Pettenkoffer was able to demonstrate
from experiments, that, if many persons are in a confined place, it is
not carbonic acid alone that causes the very disagreeable sensation of
the foul air, but that it is a consequence of the accumulation of
harmful products of perspiration through the skin, the particular nature
of which has not been determined as yet.
Footnote 232:
Aubert: Pflüger Archiv, vol. vi, p. 539, 1872.
On this account it is permissible to speak of a respiration through the
skin, although it has not yet been demonstrated by exact methods that
the skin is really absorbing small quantities of oxygen; and it is even
now not yet beyond doubt whether the small amount of carbonic acid may
not be ascribed, perhaps, to the decomposition of the excretions from
the skin, and of the epidermis that is shed, as stated by Prof.
Bunge.[233]
Footnote 233:
Professor Bunge: Lehrbuch der Physiologie des Menschen, Leipzig, 1905.
But if it is not possible to prove the certainty of respiration through
the skin to a degree that would satisfy the postulates of exact science,
on the other hand the observations of ancient savants, whose chemical
knowledge and powers of observation were not inferior to those of their
present successors, in spite of a deficient education in chemistry, all
point to its existence, and we shall have to take it into account.
As a rule the various products of skin perspiration cannot be seen, as
they are eliminated in the form of vapor. This evaporation takes place
in this invisible form, however, only when it is not checked or when it
is not produced in excessive quantity. But when such evaporation is
hindered by clothing that is impermeable to such products, such as
rubber clothes or fur, or when it is too abundant, then it will be
eliminated in the form of water through the pores, and will appear in
drops. The human body loses from 1 to 1½ liters of this moisture, that
is to say, sweat, in a day.
Such checking of evaporation produces a very disagreeable feeling, a
fact that indicates the existence of skin respiration; as does also the
circumstance that persons clothed in a way that permits of the
circulation of air to the skin and the elimination of the products of
perspiration, and who also use other means for maintaining a good
hygiene of the skin, such as a bath, are always in better health than
those who neglect these points.
That the retention of various harmful products normally eliminated
through the skin is extremely injurious to health is best shown by the
fact that animals whose skin is varnished all over invariably succumb to
intoxication. Especially is this true in amphibia, who, as
Spallanzani[234] found, can live longer after the removal of the lungs
than after varnishing the whole skin. The cause of this is that in
amphibia the respiration by the skin is more important than that through
the lungs.
Footnote 234:
Memorabilien traduits par Levebier, p. 77, Genève, 1863.
But even if, in higher animals, there is far more respiration through
the lungs than through the skin, the varnishing over of the skin on the
entire body can produce death in certain mammalia. This has also been
observed to have occurred in man. The day before the solemn entry into
Rome of Pope Leo XIII, a little boy was painted over his entire body
with gold leaf so as to represent an angel; but he suddenly died before
the procession began. We cannot, however, conceal the fact that the
death of higher animals, according to some authorities, is not due to
the retention of the products of perspiration, but rather to an
increased loss of warmth of the body, especially as these animals have
always been shaved prior to being varnished.
Still, for reasons we shall give later, we believe that this cannot
alter our views on the harmfulness of checking respiration through the
skin. The injurious action of this is also shown by the fact that
persons whose skin is burnt to a large extent, die, as a rule, by
intoxication. Certain opinions have been advanced which ascribe such a
death to a change in the constitution of the blood after extensive
burns. I am inclined to think that death may be due to the fact that the
skin respiration is, in such a case, more suppressed, as the body is
enveloped in bandages which, like sticking plaster, do not admit of air
circulation; and also because there is no elimination. At the same time
the other parts of the body are covered by the clothing instead of the
same being removed. If, however, after such burns the body be kept quite
naked and the air thus permitted a free circulation on all sides, then
even after the most extensive burns death will not follow, as we have
seen in several cases so treated by Dr. Sneve in St. Paul, Minn., whose
wards we inspected some years ago. Why should the changes in the blood
not induce death in these patients in the same way as it does in
patients swathed in bandages? Logically, this cannot be the reason for
death, but in all probability it is the suppression of the skin
respiration. But if death after extensive burns is due to this cause,
then the same may be given as the cause of death after varnishing the
body. The substances which are eliminated from the body through
perspiration are urea, uric acid (in small quantities only), common
salt, creatin, acetic acid, lactic acid, and a number of fatty acids.
Although exact science does not demonstrate that poisonous matters are
eliminated through perspiration, still some very noted men, like Ortner
and Goldscheider, are convinced of it. Arloing contends that the
perspiration of even a healthy man is toxic, whereas Queirolo admits
this to be so only in the case of sick persons.
We shall also be able to realize the great importance of the skin as an
eliminating organ for toxic products after a little consideration on the
origin of skin diseases, which we believe are due to two principal
causes: Firstly, the invasion of microbes into the skin after a
diminution of its resistance, which, in turn, is dependent upon the
condition of its nutrition by the blood. This is the external cause.
Secondly, by the elimination of toxic products which are formed in the
body and then pass through the skin. These may have originally been
introduced from the outside, either by food or by drugs, or they may
have been produced in the body through products arising from certain
glands, such as the thyroid, sexual glands, etc. The waste products of
metabolism, such as uric acid, may also be included in this category.
This is the internal cause of skin diseases. Both of these causes may
stand in relationship; thus the existence of the second may favor the
development of the first.
For the subject now under consideration the second cause is more
important, and we will say a few words on the matter as showing the
importance of the skin as an eliminating organ for toxic products.
We may frequently see persons who are affected by eruptions on the skin
after eating certain kinds of food, as oysters or strawberries; and
especially after eating oysters which have not been absolutely fresh. In
our own case, and in many others which we have observed, an eruption of
acne on the face has followed the eating of cheese. A similar state of
things may result from taking certain drugs; thus, after bromine or
iodine very often acne may be observed on the face. This interesting
fact we have experienced personally and have noted in patients who have
taken thyroid tablets in certain quantities, which also contain iodine.
If we examine acne eruptions we find in them certain microbes, such as
the bacillus of Unna, etc. In gout, which is caused by the retention of
uric acid, skin diseases are very frequent.
Sufferers from Graves’s disease, in which there is, as has been so often
mentioned, a hyperactivity of the thyroid gland, have very frequently
cutaneous eruptions, including acne, and often also a very irritating
pruritus. Also in diabetes, in which thyroid hyperactivity plays a
prominent rôle, it is not so much the sugar as the factor I have
referred to, which is the cause of the great frequency of skin diseases.
Here also a number of toxic products are eliminated through the skin.
In women, during menstruation, we often see cutaneous eruptions, as acne
or hives. The former is often very distressing in boys and girls in the
years of puberty, and it is quite impossible to deny that this may be a
symptom of a hyperactivity of the sexual glands. Thus, we often observe
acne in persons who are masturbating, or who for a long time live in
complete sexual abstinence, so that in certain places the laity term
these “pimples of chastity.” Here, again, married life is the best cure
for this disease, as it is for so many others.
It is very interesting to note during the question we are now discussing
that persons suffering from psoriasis feel relief from their affection
when they have had a good opening of the bowels, or when they perspire
freely; hence in hot summer weather they suffer less inconvenience than
in the winter; also by following a certain diet this disease may be
favorably influenced; that is to say, such persons have fewer psoriatic
patches when the toxic products are eliminated by the intestines or
kidneys. When there is a hyperactivity of the skin function, as in
perspiration, the toxic products are eliminated in the vapor or moisture
of the perspiration, but during a diminution of this function they form
the psoriatic patches.
When the skin function is increased, as in sweating, a number of
products that are otherwise eliminated through the urine pass through
the skin, which may eliminate a considerable part of the solid waste
products, and particularly a very important chemical product—common
salt. When the kidney is diseased the elimination of common salt and
other substances may become difficult, and thus still more injure the
kidneys; these products, and especially the common salt, will be
retained. Then comes the skin to the assistance of the kidneys. Not an
inconsiderable part of these substances may then pass through the skin
when it is in a condition of increased activity, in the form of sweat.
Thus the kidneys and skin work in harmony; they are companions, and may
be graphically called “Kidney and Co.,” the skin being the second
partner. The skin is thus one of our most important organs, and in the
following chapter we will deal with its hygiene.
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CHAPTER XXIV.
THE HYGIENE OF THE SKIN—AIR BATHS.
IN another part of this work we have attributed to the kidneys a very
important part in the causes of premature old age, as their degeneration
is one of the most striking causes of auto-intoxication, the immediate
cause of old age. The more injurious the products passing through the
kidneys, the quicker will these noble organs be degenerated and the
sooner will they decay.
It will thus be the wisest policy in the prevention of premature old age
and in the interests of a long life, to lighten the work of the kidneys,
and avoid their being overstrained by throwing a part of the work on
their partner—the skin. This organ, as stated at the close of the
preceding chapter, is, in a certain measure, a co-partner with the
kidneys. When, through cold weather, for instance, the functions of the
skin are diminished, a greater flow of liquid will pass through the
kidneys in the form of urine; but when the weather is hot and there is
perspiration, to a certain extent, less liquid will be secreted and
excreted by the kidneys: that is, they will work less. By perspiration,
also, more common salt will pass through the skin, and consequently less
through the kidneys.
It follows logically from these considerations that if we are anxious to
preserve the vitality of the kidneys and also free the blood from
noxious elements, we must pay special attention to a good action of the
skin, and this is only possible by a rational hygiene.
The sudorific glands are abundantly provided with small blood-vessels,
which bring a large quantity of warm blood to them, from which they
absorb watery and solid parts, and, in all probability, gaseous
substances also, and pass them through their tortuous excretory channels
to the surface of the skin. The mouths of these channels are the pores,
and it is of fundamental importance that they remain open; for if closed
these waste products cannot pass out and must remain in the body, while
in addition no air can pass into the pores, and so no exchange of
materials can take place.
These pores can easily be clogged; for example, by the
scales—cuticle—which we shed every day, mostly from the superficial
layers of the skin, and also by the oily secretion of the sebaceous
glands. The fat that these glands secrete is intended by Nature to serve
as a protection against liquids, like water, and against the
perspiration from the skin. In some persons this fat is secreted in too
large quantities and may then, especially with its products of
decomposition, clog the pores. In the same way the products of
perspiration, and also foreign materials, such as dust, may close the
pores. It will, therefore, be necessary to remove all these substances
which are preventing the proper aëration of the skin and the elimination
of harmful matters by it. It is also not impossible, when the products
of decomposition of the sweat remain long in close contact with the
skin, that some of those injurious elements may be re-absorbed.
The best method of getting rid of these harmful substances is by bathing
every day. But water alone, except it be very hot, and the bath of long
duration (and in this case it presents some inconvenience and may be
injurious also to health if taken daily), is not able to remove the oily
and fatty products of the skin. Therefore it is best to use soap in
addition to water, and to rub energetically with it the entire skin
surface of the body.
Besides removing, by a bath, the injurious products that clog the pores,
we must take particular care to allow air to penetrate to the pores as
freely as possible, thus permitting a free issue to the body exhalations
and facilitating respiration by the skin.
We should not, therefore, exclude the air by thick, non-porous clothing,
such as furs; nor should we use underwear that fits too closely to the
body. To permit of a thorough aëration of the skin it would be
advantageous to remain exposed naked to the air once or twice during
each twenty-four hours, and each time for at least five to ten minutes.
When the weather is warm and we bathe in the sea or a river, we combine
the advantages of a water and air bath. But in places where there is no
sea, lake, or river in which to bathe, we could, if living in the
country, enclose some spot for such an air bath which, in sunny weather,
would also become a sun bath at the same time. On the grass of a
clearing in a wood, or in a garden, such an air bath could best be
taken. In summer, if the air is not too warm, and if we are in the sun,
we may remain longer than ten minutes in such an air bath.
If we are not able to procure a place in which such a bath can be taken
quite naked without being seen, the next best thing is to clothe oneself
in amply large white pajamas, or, for women, in a very wide white mantle
or costume of the empire style, and thus attired to take a walk in the
garden or ground of one’s property.
In cities many can take such an air bath in one room every day when they
can spare ten minutes, the best time being before dressing and after
undressing. But also during the day, especially in summer, we should
spare a few moments to take such a bath. In winter the room must, of
course, be warmed for the purpose. In combination with the bath,
breathing exercises can also be performed to great advantage in the way
described in the chapter on the advantage of open air. In order to avoid
catching cold in such an air bath it is advisable to rub the entire skin
surface of the body. This causes much blood to be brought to the skin;
thus more blood is conveyed to the sudorific glands which are thereby
enabled to absorb a larger quantity of harmful matters from it, while at
the same time more air can be taken in by the pores. While rubbing—which
is best done by a brush—we can also move about, and while standing also
beat the periphery of the body with a thick rough towel in the same way
as in Finland they do with brushwood after hot baths. It is not painful
and is very effective in producing a hyperæmia of the surface of the
skin. When the skin is thus better nourished with blood it also offers
more resistance to germs that may cause diseases of the skin, and such
better nutrition and its improved hygienic condition is a safeguard
against catching cold.
Such an occurrence is more likely to occur in persons who neglect a
thorough cleansing of the body daily by baths and who go warmly clad; in
such cases the muscles which contract the pores are less active, and
because of this more body heat is lost and catching cold more easily
takes place. When we feel warm more blood circulates through the skin,
and when afterward cold air reaches us the pores, in a normal person,
contract quickly and the blood is retained in the interior of the body.
Thus we are prevented from giving off too much warmth from the body and
catching cold. Persons who have been trained since their early childhood
to cold water and cold air show a great facility for reaction against
cold. When cold air reaches the skin, which on account of warm
surroundings has become warm, filled with blood, red, and moist, the
skin will contract and become pale, the easy conduction of warmth will
be checked, and the heat retained in the body. Thus such persons will
not so easily catch cold as others whose skin is not kept in good
hygienic condition.
Many people have already shortened their existence by catching colds.
Pneumonia, pleurisy, nephritis, and many other dangerous ailments have
arisen from such a cause and led to premature death. A good hygiene of
the skin not only serves to eliminate toxic products from the body and
keep our kidneys in good order, but also prevents the tendency to
catching cold, which is so often the cause of an early death. We must,
therefore, do our best by a careful rational attention to the hygiene of
the skin, and for this purpose we will deal further with the subject in
two chapters on the hygiene of the skin by bathing and by rational
clothing.
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CHAPTER XXV.
ON RATIONAL CLOTHING.
THE chief object of rational clothing is to obtain porosity. All
underwear as well as outer coverings must be made out of some porous
substance which will in no way check the perspiration from the body or
the evaporation of such perspiration, and which will at the same time
allow of a free passage of air to all parts of the body.
First, we will discuss the question as to the nature of the underwear
which is most appropriate for keeping ourselves in a healthy condition.
Wool is the most suitable material for warmth for underclothing, as it
is a bad conductor of heat and can therefore best retain the natural
heat of the body. It follows, therefore, that this is the best for aged
persons to use.
In old age, especially when very advanced, less natural heat is produced
in the body. On account of the degenerative changes of the small
capillaries the surface of the body is not so well provided with the
heating element, which is the blood. At the same time, on account of the
loss in elasticity of the musculature, the skin of an aged person
contracts less readily from cold than does the skin of younger people;
thus, while on the one hand less warmth is produced, on the other hand
more warmth may be given off, a due consideration of which leads to the
logical conclusion that all aged persons had best wear woolen
underclothing.
Woolen underwear, though the best to retain the warmth of the body, has,
on the other hand, very serious drawbacks. Wool possesses the great
advantage of easily absorbing the perspiration of the body; it can, in
fact, absorb about 40 per cent. of the moisture, by weight, without
becoming so saturated as to be noticeable; but at the same time it gives
off this moisture again very slowly, necessitating the changing at once
of such damp covering.
The greatest drawback to wool, however, is that it soon loses its
porosity after it has been washed, for then it shrinks and its meshes
contract, and in consequence the material is no longer porous; while in
this condition it does not freely give off the moisture, but retains it,
the aëration of the skin is seriously hindered, and the products of
perspiration are not gotten rid of.
Everybody knows what a disagreeable feeling is produced by keeping on
such underwear after it has become dampened by perspiration, and this is
due to the prevention of the dissemination of the exhalations from the
body. Such disadvantages to the wearer of woolen underclothing may
possibly be discounted by making such underwear with large meshes; but
even in this case it is not easy to prevent the loss of porosity after
washing. It is therefore advisable to wear a large meshed linen garment
next the skin under the woolen underclothing; there will thus be a
cushion of air between the skin and the woolen garment; and linen also
has a great affinity for absorbing moisture and rapidly giving it off
again.
All kinds of underwear, whether of wool or other material, should be
loose about the body. It is a great mistake to have it too tight. There
should always be a considerable layer of air between the clothing and
the skin. This layer is warmed by the blood at the surface of the body,
and as air is a bad conductor of heat, even in the case of underwear not
so thick as wool, if such clothing is worn somewhat loosely about the
body and is porous, we shall not feel cold. The porosity of the tissue
permits the entrance of air, and such tissues, with air in their pores,
are abstracting a minimum of heat from the body, though such pores in
the tissue allow for the free passage and exit of the harmful
exhalations and evaporations from the body.
From the foregoing it follows that socks which do not fit too tightly
but fairly loosely, and which are made of porous material, such as good
wool, will also be the warmest. It is quite unnecessary to adopt heavy
double socks which fill up all the space in the shoes; as a matter of
fact in such a case we may have colder feet than if we wore light porous
good woolen socks that do not fit too tightly.
Linen possesses the great advantage that it easily absorbs moisture and
easily gives it off again, but as it is not such a bad conductor of heat
as wool, and freely gives off heat, it may most advantageously be
utilized in warm weather, and also in winter if worn under the other
woolen garments.
Linen is superior to wool in so far as the matter of cleaning it is
concerned, as it can be washed much more thoroughly than wool, which
easily retains dust and dirt. Linen is one of the most porous substances
for underwear.
Ramie is a material made from a tropical plant, the _Bæhmeria Nivea_,
and has lately come much into use. It readily absorbs the moisture from
the skin and does not retain it as long as does wool, but rapidly gives
it off again. It also does not abstract warmth so much as linen, and
next to wool is the warmest material for underwear. The drawbacks to it,
however, are that it is too heavy and does not last long. Silk underwear
also retains the warmth, and also very easily absorbs moisture; but it
is too expensive for ordinary use, and can readily be spoilt by
indifferent washing, unless the most expensive quality is used.
Of all the various materials for use as underwear possibly cotton has
the greatest average advantages. It gives off the moisture it has
absorbed from the skin, although not quite so efficaciously as does
linen. According to James Paton it absorbs moisture equally well as
linen; but Pettenkoffer is of a different opinion, as in his view cotton
does not absorb the moisture from the skin as readily as does linen.
The greatest advantage, however, of cotton over all other kinds of
material (except perhaps ramie) for underwear is its porosity. It is
about the most porous material there is, especially if in the course of
manufacture the maker takes particular care in selecting the very best
cotton; it does not shrink like wool, and therefore does not lose its
porosity in the same way when washed.
When cotton is so manufactured as to present the greatest possible
porosity, it has also the great advantage of being almost as warm as
wool, which is due to the fact that air can enter freely everywhere and
remain in the interstices of the material. It has already been mentioned
that air is a bad conductor of heat, so that cotton underwear of good
quality retains the warmth of the body and at the same time allows a
free exit for the exhalations of the skin. If, therefore, cotton be
prepared from the best possible material, and manufactured in such a
manner as to obtain the greatest amount of porosity, i.e., when it is
loosely woven, it can compete successfully with wool as material for
warm underwear; it is, therefore, quite an erroneous view to hold, as so
many do, that cotton is very different in this respect from wool;
everything depends upon the _quality_ and the manner in which it is
manufactured.
According to the researches of Sir William Thompson[235] there is
practically no difference between wool, cotton, and linen in regard to
their capacity as conductors of heat. Nevertheless we ourselves still
believe that in winter weather, or when there are cold northern winds,
wool is best, especially for the aged. This same holds good also for
those younger persons who catch cold easily.
Footnote 235:
Sir William Thompson, in “Heat,” Encyclopædia Britannica.
In order to keep warm in winter it is, however, necessary that the
cotton material should be of a certain thickness, besides being of the
best quality and of the best make. As already mentioned it is of the
utmost importance that the underwear should not fit too closely around
the body, but that there should always be a layer of warm air between
the skin and the garment. Instead of the present custom of wearing
close-fitting trousers it would be much more beneficial to adopt the
very large loose linen trousers that are worn in certain countries, such
as Hungary. When once accustomed to such, and especially in the case of
the younger generation, they can readily be worn also in winter time.
Then, possibly, porous cotton can take the place of linen, although many
people may feel just as warm in porous linen underwear; or we could
possibly follow the example of an English gentleman who told me he never
wore any underdrawers at all.
In many European countries women, especially of the lower classes, wear
no undergarments on their legs at all. In healthy women such a custom
may be of great advantage, as it permits of the free passage of air and
the elimination of the perspiration from the skin, being in effect a
continuous free-air bath for the lower parts of the body.
It is not so necessary to keep the lower extremities, except the feet,
warm (provided that the feet are made warm by the constant motion of
their muscles), as we do not need to be so well protected there as on
the upper parts of the body; we also feel the cold less in these parts,
which we can all appreciate if we are in the habit of walking much and
not sitting about all day.
Before putting on clean underwear we must be careful to ascertain that
it has been thoroughly aired and is quite dry, for it happens in more
cases than one knows of that the linen arrives from the laundry quite
damp, although apparently it appears and feels dry. After having caught
cold each time I changed my linen, after having perspired, I had the
idea to put my vest over an electric lamp, and was surprised to see a
cloud of moisture arise from it. As moisture readily absorbs the warmth
of the body, we can therefore easily lose too much warmth and thus catch
cold. Before putting on clean linen it is also advisable to rub the body
with a brush (or rough towel) until the skin glows, and the linen itself
should of course be put into a hot-air cupboard or be aired before a
stove or fire, by which means many colds will be prevented; and these
precautions are particularly necessary in all cases after free
perspiration, in which latter case also a bath is very desirable before
putting on our clean linen. It is of primary importance to change
underwear every day, so as not to leave the products of perspiration on
the skin for several days (see chapters on the hygiene of the skin and
kidneys through perspiration).
We will now offer a few remarks on the subject of white linen. We should
not wear starched linen shirts, as they are less permeable to the air.
In lieu of these, porous linen shirts are advisable, or any other kind
of soft and porous material, without a starched front. The use of
starched shirts should be confined to dinner parties and social
functions.
The most absurd part of our linen outfit is unquestionably that
instrument of torture we wear as a yoke around our neck, preventing a
free circulation through our most important arteries and throttling one
of our most important organs—the thyroid gland. This we know as the
“starched collar,” without which we must not appear in decent society.
It is in any or all of its present shapes an unhealthy article of
clothing, but especially so when, from foolishness, it is worn standing
high up to the chin, keeping away the air from the neck and hindering
free circulation. Its bad effects upon the thyroid have already been
referred to in the chapter on the hygiene of the thyroid gland. It would
be more reasonable to wear a low collar, turned down, and of soft linen,
as worn by our forefathers. Women may have this privilege, but, sad to
say, they do not avail themselves of it, but instead, in many instances,
cover their necks, and even more than their neck, by impermeable
materials. Yet the neck is one of the parts of the human frame where
many sudorific glands are situated and where we perspire freely. These
parts especially should not be enclosed by clothing; neither should the
armpits and the toes of the feet, for here the sudorific glands of the
body are very numerous. Yet we wear the most impermeable materials, such
as leather, and often indeed thick leather, and _horribile dictu!_ even
rubbers, very often, on these important organs.
The outer garments should also be made, after careful consideration, to
afford the greatest amount of porosity. It would be the height of
hygienic triumph to wear clothes made to allow of the free inlet of
wholesome sunlight. Gray garments are, therefore, the best, and next to
this blue should be greatly preferred to dark colors.
The overcoat should never be too heavy nor too warm; as a general rule,
we should never wear clothes warmer than the temperature at the time
requires, always being guided by the thermometer and not by the
calendar. It is much better to be clad too lightly than too warmly, for
we thus avoid perspiring and thereby catching cold; or, in other words,
if clad simply lightly the likelihood of our taking cold is less than
when we are too warmly clothed, for then we also perspire less freely.
It may be that we shall more readily feel cold, but, fortunately, the
sensation of feeling cold does not imply catching cold. In fact, when
lightly clad we feel much more inclined to take brisk exercise. Then we
feel warm, and, as we shall show in the chapter on exercise, more blood
is sent to the periphery of the body and the general nutrition of the
skin is increased. Naturally, when we are lightly clad we do not sit
about without moving, but we endeavor to create a reaction in the skin
by brisk exercise. Englishmen, and especially Scotchmen, rarely wear an
overcoat, never sleep in a warmed room, and rarely ever catch cold,
which is certainly much more prevalent in countries with overheated
houses, as in America, and where the people are more accustomed to ride
in the street cars (also heated) than to walk.
Catching cold is best obviated by hardening the body against the
influence of cold, and this is best done by a continual aëration of the
skin, and by means of cold baths, commenced in a judicious manner. We
should become accustomed to permit the entrance of air as frequently as
possible to the whole surface of the body, which we can do by remaining
stark naked in our room for only a few moments several times a day, as
already advocated in the chapter on the hygiene of the skin. But still
more important is free access to the air, even though cold, if we desire
to be immune against colds. Most people who do catch cold contract it
first in the head, especially after being in a state of perspiration.
The frontal and temporal parts of the head are very well provided with
sudorific glands, and it is therefore most unreasonable to prevent free
air access by a warm covering. It is also unnecessary, because Nature
has already provided these parts with a natural covering, viz.: the
hair, which, with the skull, is intended for the adequate protection of
our most delicate organ, the special construction of which places us
above all other animal creation.
That young men with abundance of hair should wear heavy head coverings
is extremely unreasonable. It would be a far more healthy custom to go
without a hat, and thus preserve for a much longer period this natural
ornament to the head. At the same time we would perspire less in the
head and thus be less liable to take cold. By continuing this practice,
as is customary among the boys of a certain English school (The Blue
Coat School), the scalp of the head will become so much hardened against
climatic influences that we should be able to go out with uncovered head
even in cold weather. As, however, not all our neighbors and
acquaintance are keenly interested in the postulates of health and long
life they may laugh at first, but afterward they will themselves be
converted by the advantages of such a custom and will follow our
example.
Those whose scalp has become bald or only scantily covered with hair, by
excluding from the same too much air or by reason of disease, may not so
readily stand the effect of the cold, and for such a head gear may be
necessary, in which case the preference should be given to soft and very
light felt hats, and not to those made of hard material, which prevent
the circulation of the blood through the scalp and thus kill the roots
of the hair.
Those who are slaves to the prejudices of their short-sighted brethren
may wear their hat when in their company or in the streets, but by all
means take it off at other times, and especially when in the woods or in
the fields.
It is a singular anomaly that the English, who in many questions of
hygiene, as by conducting their sports in the open air, stand at the
head of all nations, yet obstinately stick to their tall hats and long
black coats in the warmest summer weather, sacrificing health and
comfort to social prejudices. How long will Bacon’s nation persist in
such a custom?[236]
Footnote 236:
Latterly city men wear straw hats in summer and also the coachmen and
servants of the upper class.